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Massive Ipsilateral Hypertropia after Peribulbar Anesthesia

Weigmann U., Steffen S., Glombik E., Wiechens B.,
Klinikum Hannover Nordstadt, Augenklinik (Hannover)

Purpose: Vertical strabismus is a rare complication after cataract surgery. Most comon is a hypotropia after retrobulbar injection caused by contracture of the inferior rectus muscle. We present a patient with persistent massive ipsilateral hypertropia after peribulbar anesthesia.
Method: We report of a 80 years old female with hypertropia of 27° 12 month after external cataract surgery of the right eye. The cornea was almost totally covered by the upper eyelid. We ruled out undergoing neurological disease by MRT and examination so thas strabismus surgerywas performed.
Results: MRT and ultrasound did not disclose any muscular pathology. Prism and covertest shows -7° +VD 27°. The forced-duction testing was reduced for downward gaze. During surgery the examination of the superior rectus muscle demonstrated a contracture. We did superior rectus muscle recession and folding of inferior rectus muscle. The cosmetic outcome was and function result was satisfactory. There was a mild hypertropie of 5° without diplopia.
Conclusions: Contracture of vertical rectus muscle is more common in inferior rectus after retrobulbar injection. In our patient a massive superior rectus muscle contracture after peribulbar anesthesia occured. A supposed reason is ischemia after laceration of the anterior ciliary arteries. Strabismus surgery was the proper treatment to help our patient.